Wow! Have given lots of loading doses IV push and never seen this. I
wonder if it was something about the patient's chemistries that
caused it. Lynn
At 8:57 AM -0500 2/15/06, Martha Pike wrote:
let me clarify..
What I have actually seen occur and felt occur at the catheter tip
as the phenytoin was infusing or being injected was the drug
precipitating.
You could feel the clumps form immediately as the drug came out of
the catheter tip and hit the blood stream. You could also actually
see the clumps form as this was being given through relatively
superficial peripheral veins.
While both thrombus and extravasation are well known and frequent
complications of phenytoin administration, that was not what I was
seeing with this particular patient.
This was in severely compromised patient, with a large dose of phenytoin.
We did not have the labs back when this occurred, but the patient
was probably acidotic.
The patient was a young male with large easily accessible peripheral veins.
We tried both direct IV push and bolus diluted in NS.
At the beginning, the MD felt that there was no time in this
particular situation to place a central line. After restarting the
IV 4 times with exactly the same results, it was necessary to place
the CVC to administer the drug successfully.
(I'm old, this was before fosphenytoin existed.)
/Martha - Boston
--
Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
